IRRITABLE BOWEL SYNDROME
WHAT IS IT?
Irritable bowel syndrome-IBS-shows up in a number of ways that may include gas, bloating, and cramps or pain in your stomach or abdomen. Sometimes you’ll also have changes in bowel movements such as constipation or diarrhea.IBS is the most common of all digestive ailments. At least 10 to 15 percent of adults have it at some time in their lives-three times as many women as men. It’s also one of the toughest to pin down, because it can mimic the symptoms of other problems that are more serious. It is not a big threat to your health: IBS doesn’t lead to cancer or any fatal bowel diseases. Some people, though, may be so bothered by it that they don’t want to travel or go to social events.
Most people with IBS can keep it under control with diet changes, by dealing with stress, and sometimes with medications.
WHAT IS HAPPENING?
After you swallow food, it mixes with acids and enzymes in your stomach. These break down the food as it moves along to your small intestine. The intestine breaks down food even further and absorbs its water, vitamins, and other nutrients into your bloodstream. What’s left then travels into your large intestine, the colon, which takes out more water and salts. Finally, the solid waste-stool-that can’t be digested or absorbed passes out of your body.
During the entire process, muscles in your intestines push food along with waves of squeezing motions called peristalsis. Irritable bowel syndrome occurs sometimes when these motions lose their rhythm and upset the process. Muscles may then squeeze too hard, or not enough. If they push the stools along too fast, your large intestine doesn’t have time to take out enough water. The result is diarrhea-loose, watery stools, sometimes with cramps or pain. If muscle rhythms are slow, the intestine absorbs too much water, so stools get dry and hard. The result is constipation.
WHAT CAUSES IT?
No one is sure what causes IBS. Some experts suspect that some things, such as certain foods or stress, can trigger flareups and make symptoms worse.
Diet
Symptoms including diarrhea and cramps often come on after a meal. Foods don’t cause IBS, though. If your intestinal muscles are apt to lose their rhythm for any reason, certain foods may send a signal that starts an upset.
For many people with IBS, trouble often comes from the fat in food-from oils, margarine, meat, and dairy products such as whole milk, cheese, butter, and ice cream.
Dairy products bother some people, not because the foods contain fat but because they contain lactose, a type of sugar. These people can’t digest the lactose-they’re lactose intolerant. It gives them gas, diarrhea, and other symptoms of IBS.
Foods such as beans, cabbage, broccoli, and some fruits make lots of gas, and that can produce symptoms of IBS. Some people also have trouble with wheat, corn, eggs, spicy foods, or foods or drinks that contain caffeine or alcohol. Others may have trouble with food additives-for instance, monosodium glutamate (MSG) and the artificial sweetener sorbitol, often found in sugar-free gum and candy.
Stress
Many people find their IBS symptoms get worse when they’re tense or upset. This doesn’t mean IBS is “all in your head.” Rather, people with IBS seem to have bowels that are highly sensitive to stress. And worrying about what’s going on can make your distress worse.
WHAT YOU CAN DO FOR YOURSELF
While there’s no known way to prevent IBS, you can do a lot to prevent flareups or ease symptoms when they occur.
Keep a food diary
If you’re not sure which foods cause your symptoms or make them worse, keep a food diary for a week or two. List all the things you eat and when you eat them. Also note any symptoms you have, what time they come on, and how strong they are. After a while, you may begin to spot patterns: Certain symptoms might always occur after you’ve eaten a certain food. If so, avoid that food for 10 days to a month and see if your symptoms quiet down. If they don’t, avoid the next food you suspect. After things improve, try adding the last food you avoided back to your diet, a little at a time. If you have a flareup, you’ll know what’s to blame.
Cut down on fat
A low-fat diet may help you avoid IBS symptoms. Of course, there are many other reasons to stick to a low-fat diet. It will help you keep your weight down. And it will cut your risk of heart disease and perhaps even some types of cancer.
Simple things you can do to cut fat from your diet:
Read food labels to know what you’re getting. The important things to look for are calories, calories from fat, total fat, saturated fat, and cholesterol. Also, note if “hydrogenated” or “partially hydrogenated” vegetable oil is on the list of ingredients and try to steer clear of foods that contain it.
The American Heart Association advises keeping your fat intake under 30 percent of your total calories each day. That could mean only 750 calories a day, or even fewer, from fat. (Just one tablespoon of butter has about 100 calories.) Not everyone agrees with the 30 percent recommendation, however. Some experts think you should go for 20 percent or less, while others say if you’re trim and lean, you can be healthy if you get as much as 40 percent of your daily calories from fat, as long as most of this fat is the unsaturated kind. If fat triggers your IBS, you can learn from experience how much fat is too much for you.
If you eat red meat, make it a once-in-a-while treat, not a regular item, and keep it lean. Look for cuts graded “select,” which means they have the least fat. Other low-fat cuts include pork loin, lean center-cut ham, venison, veal chops or roast, and lamb flank. Before cooking chicken, remove the skin and fat. Don’t use chicken injected with salt and fat-read the package label to make sure it isn’t. Eat no more than six ounces of meat, poultry, or fish a day. Keep servings to three ounces-a cut of meat about the size of a deck of cards, half a skinless chicken breast or leg, or three-fourths cup of flaked fish.
Don’t fry foods. Bake, broil, steam, or saute in a nonstick pan.
If you eat dairy foods, go for low- or nonfat versions such as skim or 1 percent milk, and choose nonfat yogurt, ice milk, or sherbet instead of ice cream.
For salads, try an oil-free dressing. If you use oil, make it one high in unsaturated fats, such as canola, safflower, sunflower, or olive.
Read the labels on frozen dinners to see how much fat they contain. Aim for meals that have less than 10 grams of fat per serving.
For constipation: Eat more fiber
Many people with IBS find that a high-fiber diet helps relieve constipation, or diarrhea and constipation that shift back and forth. Others find that it makes loose stools and gas worse. For them, bland foods low in fiber may help. If you do add fiber to your diet, increase it slowly so that your body has time to adjust.
If you find that fiber helps, build your meals around fruits, vegetables, and grains. They have little fat and no cholesterol and are loaded not only with fiber but with the vitamins and minerals you need for good health.
Drink lots of water, too. That’s because fiber needs to absorb liquids to swell up and become bulky enough to help the colon push digested food through. At least eight glasses a day is a good rule.
If you are constipated and diet changes don’t solve the problem, try an over-the-counter laxative or fiber supplement. Don’t take over-the-counter laxatives unless your doctor says it’s okay, though, and don’t take them for more than two or three days at a time. Your body may come to depend on them for any bowel movement at all.
Eat smaller meals
Large meals can cause cramping and diarrhea in people with IBS. Try eating smaller portions.
If you have diarrhea
If you have diarrhea, avoid solid food at first, to give your digestive system a rest. Also:
Don’t let yourself get dehydrated from losing too much body fluid. The signs include dry mouth, sticky saliva, and dark yellow urine in smaller amounts than usual. Sip clear, warm liquids (water, tea, or broth), sports drinks, or flat sodas (ginger ale, cola, or other sodas that have been left open to lose their fizz). Drink only small amounts for the first few hours, then as much as your stomach can handle.
Once your stomach can handle liquids, try eating bland, bulky foods such as bananas, white rice, or toast.
There are many over-the-counter drugs that help relieve diarrhea. If you want to try one, wait a few hours to let your system get rid of whatever is causing the problem. Don’t use these products longer than two days without letting your doctor know. Side effects can include constipation, dizziness, fatigue, a dry mouth, and nausea. Also, talk to your doctor before taking any of them if you’re also taking antibiotics, or if you’re pregnant or nursing a baby.
While you’re getting over diarrhea, avoid alcohol, milk products, caffeine, citrus juice, tobacco, spicy foods, and fiber-rich foods such as salads and fruit. They could make the problem worse.
Exercise
There are lots of reasons to be active. Exercise may help ease symptoms of IBS or prevent flareups. How does it work? No one knows for sure, but some experts think it helps by relieving stress. In any event, it will help you keep your weight down, and it’s good for your heart.
If you haven’t been active for a long time but want to start, be careful that exercise isn’t a trigger for you. Until you’re sure, you may want to exercise close to home. Some tips to make it safe and easy:
First, check with your doctor about the best way to get started, above all if you’ve been inactive for a long time or if you have any risks for heart disease such as high blood pressure.
Any activity that gets you up on your feet and moving around is better than none. Start by being a little more active each day. Take the stairs instead of the elevator. Walk the dog for 15 minutes each evening before dinner. Your dog and your insides will thank you.
When you’re used to being more active, try adding some more aerobic activities to your routine. These should make you breathe harder and sweat a bit, and get your heart pumping. Brisk walking, running, biking, and swimming are all great. Take a couple of months to work up to 20 to 30 minutes at a time most days of the week.
Find something you enjoy-it’s much easier to keep exercising when you like to do it.
If you have any symptoms of heart problems such as chest pain-angina-or dizziness while exercising, stop and get help right away. Call 911.
Don’t stress out
Brief bouts of stress aren’t harmful, but a lot of stress day after day can take a toll. Built-up stress raises blood pressure, your risk of heart and artery disease, and your risk of a number of other health problems, including irritable bowel syndrome.
Your natural response to stress-any problem or high-pressure situation-causes changes in your body: Your blood pressure goes up, your heart starts to beat faster, and your body releases a number of “fight or flight” chemicals that provide quick energy.
Here are some tips for keeping on an even keel, even in stressful times:
Exercise. People who exercise often tend to feel less anxious and more relaxed.
Laugh more. Use humor to ease tense moments. Studies show that laughter releases stress-busting hormones.
Don’t be a perfectionist. Set reasonable goals and ask whether everything you do has to be the best.
Control your anger. When you’re angry, ask yourself three questions: Is this problem important? Is my anger justified? Can I do anything to fix the problem? If the answer to any of them is no, take a few deep breaths and tell yourself to calm down. If any answer is yes, don’t seethe silently; do something to change the situation.
Take breaks during a hectic day to calm down. Aim for at least 20 minutes twice a day.
Keep a pet. They may shed and slobber, but studies show their owners have fewer health problems than people without pets.
Relax through yoga, deep breathing, stretching exercises, or meditation. Since IBS can be initiated by stress, finding ways to lessen your anxieties may help reduce the chances of an attack.
WHAT YOUR DOCTOR CAN DO FOR YOU
There is no single treatment for irritable bowel syndrome. Besides the things you can do for yourself, your doctor can help you get the muscular rhythms of your intestines back to normal. He or she will ask about your diet and stress level and may suggest changes in your lifestyle. You might try mild aids to regular bowel movements such as glycerine suppositories. If those changes don’t help and your symptoms are very bad, your doctor may advise stronger medicine.
Antispasmodic drugs
An antispasmodic drug such as Donnatal or Bentyl may help ease bad attacks of cramps or pain. Side effects can include blurry vision, headache, drowsiness, or sleep problems. Drugs of this type reduce your ability to sweat. If you take them, avoid heavy exercise, above all in hot weather, so you won’t run the risk of heat exhaustion or heat stroke.
Tranquilizers and antidepressants
If being tense or upset make your symptoms worse, your doctor may prescribe a tranquilizer for a short time. Some doctors prescribe antidepressants for patients whose IBS is making them depressed.
There are many versions of these drugs. All of them can have many side effects. Tranquilizers often cause drowsiness and dizziness, as well as many other less common problems such as blurred vision or confusion. Some common side effects of antidepressants include sleeplessness and vivid dreams. You should never take a tranquilizer and an antidepressant at the same time.